Lipid lowering in patients 75 years and older

Figure 1 Alteration of cholesterol metabolism during lifetime. Dietary cholesterol is absorbed in the intestinal lumen via transport and endocytosis, which is regulated by NPC1L1. NPC1L1 mRNA expression decreases with increasing age. On the other hand, about 50% of dietary cholesterol and about 95% of plant sterols are pumped back into the intestinal lumen by ABCG5/8, which is upregulated in elderly individuals. Cholesterol is packed into the chylomicrons and transported to the liver. Chylomicron remnants are taken up by the low density lipoprotein (LDL)-receptor in the liver. Moreover, endogenous cholesterol is synthesized in the liver. Endogenously synthesized cholesterol is transported to peripheral tissues via LDL. The red arrow shows age-related up- or downregulation of different genes/proteins in cholesterol metabolism. C: Сholesterol; PS: Plant sterols, CM: Сhylomicrone; LDL: Low density lipoprotein; VLDL: Very low-density lipoprotein; NPC1L1: Niemann-Pick C1-like 1; ABCG5/8-ATP: Binding cassette transporter G5/G8.